Monthly Archives: October 2018

For thousands of years, people from diverse cultures around the world have passed on their traditions, beliefs, and advice through the telling of stories. These stories have explained the following:

• Lessons of life
• How to survive in difficult circumstances
• Why things have happened the way they have
• Tales of great adventure, tragedy or love

In addition to the wisdom passed down, we now know that reminiscence and life review is a proven way for older adults to gain self worth, learn more about themselves, and give the gift of their stories to the next generation. Recalling life stories should be encouraged at any juncture in one’s life, but primarily as people reach end of life. There are a number of studies that have shown that reminiscence and life review affects people’s lives in extraordinary ways that stimulate the brain, promote lifelong learning, and lead to healthy aging.

Brain Fitness & Lifelong Learning

Our life experiences impact the brain as we age. Every person is completely unique-with different people, events, and learning that shapes who we are. The wisdom and experience gained helps our brains prepare for the future. Engaging our brains in learning throughout our lives can help people age in a positive way. New research shows how the brain continues to adapt and gain neurons through the years if the brain is challenged.

“We can make the brain work better simply by accumulating more knowledge, which builds more networks of connections in the brain. The wisdom that we acquire can compensate for the decline that may be gradually occurring,” says James McGaugh, PhD, a Dana Alliance for Brain Initiatives member at University of California, Irvine.

Learning strengthens the brain as weightlifting strengthens the body. Focusing on learning can lead to positive aging experiences.

Healthy Aging, Wellness & Reminiscence

Human interaction matters in promoting positive brain health. “There’s a lot of evidence that other people are the most unpredictable things you can encounter. So activities that have you engaging with other human beings are a fantastic form of brain exercise.” said Lawrence Katz, Neurobiologist and Investigator at Duke University Medical Center.

Opportunities to reminisce together and learn about one another’s lives in autobiography classes show positive outcomes in community settings. People have a chance to move beyond everyday, typical conversations such as weather, health, sports, and food. Now conversations about grandparents, neighborhood, school experiences, and personal values and beliefs are more commonplace. Reminiscence opens a door to new discovery.

Genetics plays an important role in successful, active aging and wellness, but the choices people make every day are critical too. Cognitive stimulation matters, but the Dana Alliance for Brain Initiatives also noted that physical exercise, diet, social connections, how we manage stress, and seeing the self and the world in a positive way are also important too.

What the experts say….

• Dr. Robert Butler, author of Why Survive? Being Old in America, coined the term “life review” fifty years ago. Before that time, researchers and physicians saw reminiscence as just a stepping stone toward senility and dementia. He disagreed with this belief and proposed that, as people age, reminiscence and life review were a normal part of healthy aging. Now large bodies of research show the positive outcomes from reminiscence and life review.

• Dr. Gene Cohen, author of The Mature Mind, sees reminiscence as a critical brain activity and he recently remarked, “Autobiography for older adults is like chocolate for the brain.” Cohen cites a 2003 study by Eleanor Maguire and Christopher Frith that performed brain scans on people in their 70s and in their 30s while they were reminiscing. They found that the entire hippocampus is “lit up” and actively engaged in older adults, while 30 year olds only utilize one small part of the left hippocampal region.

• Dr. Andrew Weil, author of Healthy Aging, encourages older adults to keep a record of wisdom, values, and life lessons in an ethical will, or heartfelt letter to loved ones. He writes, “An ordinary will… concerns the disposition of one’s material possessions at death. An ethical will has to do with nonmaterial gifts: the values and life lessons that you wish to leave to others…At critical points in your life, take your ethical will and read it over. Add to it. Revise it and share it with people you care about. An ethical will helps you organize your own experience and focus on who you are. It’s a spiritual inventory about what you want to pass on to others.” Life stories can lead to a letter from the heart.

Skilled Nursing Care, Memory Care & Reminiscence

Studies have shown that communities see remarkable results when reminiscence and life review is encouraged.

Increases Life Satisfaction

With female nursing home residents, a study randomly assigned participants to a reminiscence group, current events discussion, or no treatment group. The results showed significant increases in life satisfaction in the reminiscence group.

Improves Resident/Staff Relations

Nursing home residents were interviewed with and without staff present and in either a reminiscence/life review format or a format more focused on the present time. The attitudes of residents toward staff improved with reminiscence and with the staff’s presence at interview.

Reduces Geriatric Depression

Newly relocated nursing home residents underwent a study to examine if life review could prevent clinical depression. Significant positive results were shown in reducing depression at the short-term testing stage with an additional decrease in depression and hopelessness at one year.

Decreases Disorientation, Improves Social Interaction

A study demonstrated it is possible for older people with dementia to reminisce and that this is meaningful for them in particular, because of the losses associated with dementia. Another related case study used life review with groups of people with Alzheimer’s disease. They were assigned to groups with some participating in life reviews and others did not. Results showed significance for life review groups in decreased disorientation and improvement in social interaction.

Increases Orientation, Competence After Relocation

A case study examined the use of a life review program with newly-relocated nursing home residents and it was found to decrease depression, while increasing orientation, perceived competence, and social interaction.

Increases Sense of Purpose and Meaning

After group therapy with older adults in long-term care setting over an 8-week period, this study found that the two treatment groups were significantly different from control group showing increased sense of purpose and meaning in their lives.

With Health Insurance and Healthcare costs continuing to skyrocket and access to trained Doctors decreasing, something needs to change. The current system is expensive, wasteful, and inefficient. We are proposing a new Gatekeeper Model that will provide Employees greater access to Doctors at a fraction of the cost with far better outcomes.

The Traditional Gatekeeper Model for Healthcare?

What was the traditional Healthcare Gatekeeper Model? The Alliance for Health Reform guidebook defines the gatekeeper/care manager as a “Health Care professional, usually a primary care physician, who coordinates, manages, and authorizes all health services provided to a person covered by certain types of health plans. Unless an emergency exists, the gatekeeper generally must pre-authorize referrals to specialists, hospitalizations and lab and radiology tests.”

Unfortunately this system was often plagued by redundancies inefficiencies, and added – not reduced – costs. It has become more and more difficult to gain a Doctor appointment and the emergency rooms are overrun. Under this system – and the other traditional norms for bringing those in actual need of care together with physicians – there is a tremendous waste of time and money!

A few vital statistics!

70% of Doctor’s Office Visits are Unnecessary

55% of ER Visits are Unnecessary

41% of ER visits are unnecessary because the Patient could not Get a Doctor’s Appointment

51% of Ambulance utilizations are unnecessary

The existing norms obviously have problems. The difficulties in gaining an appointment with a Doctor are growing. PPACA/Obamacare will make this a bigger problem. Millions of people will have new found access to health insurance and will expect access to Doctors. The old system was already dysfunctional and now will be more stained.

The new Gatekeeper Model!

Utilizing Telemedicine as the Gatekeeper to bring people quickly and efficiently together with Doctors. This will remove the Barriers between Employees and Doctors for determining the best course of medical action. Telemedicine is not new! There are a number of Vendor/Providers. Each provides a different level of service and different cost structure. Most would not qualify as a Gatekeeper! I’ll qualify the requirements below.

The Telemedicine/Gatekeeper Model is new! When the Employee or Family Member Calls the Doctor First – utilizing the Telemedicine Plan – they immediately access an emergency trained doctor who assists them with their medical need, coordinates, manages, and authorizes all health services required as part of their Employer’s Health Plan. The Gatekeeper Doctor authorizes the referral to a specialist, hospital, urgent care facility or lab for tests if needed.

Let’s look at how Telemedicine could be utilized as the Gatekeeper.

What must the Telemedicine Plan Provider/Gatekeeper be capable of providing based on the Plan Providers history and their Telemedicine Plan Design?

A case specific ROI Calculator to show the Employer, CFO, TPA, etc. the value of implementing and supporting the model.
Immediate access to emergency room trained US doctors – no messaging or call backs.
Accepts emergency and non-emergency calls.
The ability to direct the caller to Emergency Rooms or Specialists care if medically required.
The ability to prescribe needed pharmaceuticals as required based on a health history when the person joined the plan.
A doctor’s prescription medical kit – in the possession of the member – providing the proper tools to administer what the doctor directs over the phone while the member is heading to their doctor’s office, urgent care center, or resting where they are.
Follow-up with the member after diagnosis and treatment to ascertain if there are additional needs.
A focus on lowering health Plan utilization costs while encouraging the use of the Telemedicine System and their trained Doctors.
A flat, affordable monthly fee for the Telemedicine Plan that includes the cost of the doctor’s medical kit.
The Telemedicine Plan must be affordable and yet have a depth of services required to encourage Employees to Call the Gatekeeper Doctor First reducing unnecessary utilization of the core healthcare plan.
No extra fees or charges for usage by the participants or their family members.
The Telemedicine Plan must be: (1) a qualified health deduction for the Employer, (2) qualified under Section 125 for the Employees to pre-tax a contribution to the Plan, and (3) HRA/HSA qualified.
The Telemedicine Plan must provide assistance to the Broker and Employer for implementing the Plan and Educating the Employees about Calling the Doctor First and utilizing the Plan as the Gatekeeper.

The above merely describes what features the Telemedicine Gatekeeper must provide the Employer and Employees to reduce costs while increasing Doctor access.

Now let’s look at what the Employer, Broker, and Telemedicine Provider (and possibly the TPA) need to accomplish when establishing the Telemedicine Plan as a Gatekeeper:

Determine the Employer’s specific ROI for implementing the Telemedicine/Gatekeeper Plan.
Determine who will pay for the cost for the Telemedicine Plan – optimal ROI will be achieved if the Employer pays for the plan and all Employees and their Families are on the Plan.
Create an Employee Benefit Plan Design that requires the Employees and their Family Members to Call the Doctor First (unless there is an absolute emergency) to begin the process of diagnosis and how to proceed with medical care.
Include in the Employee Benefit Plan Design an added cost for Doctor visits if the Employee or Family Member does not Call the Doctor First – much like going out-of-network charges. This will help Encourage Plan and Gatekeeper Utilization, Provide Better Employee Care, and Increase ROI.
Create a systematic program – including Owners, Executives, the CFO, etc. – for Educating Managers and Employees about the Plan, Timelines for Implementation, Effective Dates for Coverage, and Proper Utilization of the Telemedicine/Gatekeeper Plan.
The Owners, Managers, and CFO must be involved in monitoring the Gatekeeper Plan to encourage Plan Utilization by Employees and in reducing unnecessary Core Benefit Plan Utilization.

Five steps to implementing a Telemedicine/Gatekeeper Plan!

Work through an ROI Calculator to establish the Potential Savings
Carefully Select a Qualified Telemedicine/Gatekeeper Provider
Make Simple Changes to the Employee Benefit Plan Design
Put the Plan in place now for the Fall Enrollment and the 2014 Effective Date
Educate the Employees and their Families about the Value of the Plan; and explain the “Gatekeeper” function
As an Employer or Broker/Trusted Advisor, the Employer, and the Employees/Families will experience an enhanced, cost-saving, Plan with Greater access to trained physicians

What’s Next – (1) As an Employer (2) as a Broker

1) Employers — Use the ROI Calculator! Whether you are Self-Funded or Fully Insured, contact us to utilize the ROI Calculator – there’s No Cost. You can see the value of moving forward with a Telemedicine Plan and even better – utilizing the Plan as a Gatekeeper. You can: (a) Substantially Reduce Health Plan Costs, (b) Reduce Unnecessary Doctor and Emergency Room Visits, (c) Dramatically Improve Employee Access to Healthcare Professionals, (d) Reduce Lost Employee Work Time and Absenteeism. Employers have realized triple digit returns on their investment during the first 12 months.

2) Brokers – Use the ROI Calculator and see what it would do for your Clients. (a) You can save your Current and Potential Clients substantial Dollars (b) Improve the Employees and their Families Health Care, (c) Gain Employees and their Families immediate access to Emergency Trained Professionals, (d) Retain and Attract Employer and Individual Clients. Employers have realized triple digit returns on their investment during the first 12 months.